Transfusion reactions and related conditions. I...
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Guideline:Guideline Summary: Transfusion reactions and related conditions. In: Blood transfusion guideline. Measure Summary
National Guideline Clearinghouse (NGC). Guideline summary: Guideline Summary: Transfusion reactions and related conditions. In: Blood transfusion guideline. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): cited 2011. Available: http://www.guideline.gov.
NOTE: This guideline summary content is published by the National Guidelines Clearinghouse (NGC), in cooperation with the guideline authoring organization(s). For additional guideline resources, visit www.NGC.gov. Neither NGC or the original guideline authoring organization(s) approve of or endorse any product or service offered on this website. These NGC guideline summaries reside in the public domain and are displayed by GuidelineCentral.com as a convenient reference service for our customers visiting this website.
Transfusion reactions and related conditions. In: Blood transfusion guideline.
Transfusion reactions and related conditions. In: Blood transfusion guideline. Utrecht (The Netherlands): Dutch Institute for Healthcare Improvement CBO; 2011. p. 278-320. [156 references]
This is the current release of the guideline.
FDA Warning/Regulatory Alert
Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.
August 1, 2013 – Acetaminophen : The U.S. Food and Drug Administration (FDA) notified healthcare professionals and patients that acetaminophen has been associated with a risk of rare but serious skin reactions. Acetaminophen is a common active ingredient to treat pain and reduce fever; it is included in many prescription and over-the-counter (OTC) products. These skin reactions, known as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP), can be fatal. These reactions can occur with first-time use of acetaminophen or at any time while it is being taken. Other drugs used to treat fever and pain/body aches (e.g., non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen) also carry the risk of causing serious skin reactions, which is already described in the warnings section of their drug labels.
Blood transfusion-related reactions
Critical CareEmergency MedicineFamily PracticeHematologyInfectious DiseasesInternal MedicineNursingObstetrics and GynecologyOncologyPediatricsPreventive MedicineSurgeryThoracic Surgery
Advanced Practice NursesClinical Laboratory PersonnelHospitalsNursesPhysical TherapistsPhysician AssistantsPublic Health Departments
To create a multi-disciplinary guideline on transfusion policy of blood and blood components
To stimulate a more uniform clinical thinking and acting in the field of blood transfusion
To confirm the role of nurses in blood transfusions
To incorporate new national initiatives – such as the creation of the Transfusion Register for Irregular antibodies and X match problems (TRIX) database for irregular red cell antibodies
To clinically evaluate transfusion and the clinical transfusion research to support the basis for guideline development and skills improvement of employees involved in blood transfusion, with a focus on the hospital situation
To discuss the requirements that a hospital must meet concerning the monitoring of the transfusion chain, such as having access to a functioning blood transfusion committee, a haemovigilance official, a haemovigilance employee, and a training and further education program for all those involved in the transfusion chain
Patients of all ages in the Netherlands who might require blood transfusions, either in the hospital or outside the hospital, for example in the independent treatment centres (ITC) and via home care organisations
Interventions and Practices Considered
Observation of patient for 5 to 10 minutes after starting the transfusion
Measurement of vital functions (heart rate, temperature, blood pressure)
Management of acute transfusion reactions
Determination of differential diagnosis
Management of anaphylaxis
Clamping and disconnection of blood component
Use of hospital protocols for disconnection, transport, storage and sampling of blood components
Management of non-infectious complications of infusions
Serological testing, haemoglobin and haemolysis parameters
Maintenance of diuresis (sodium chloride infusion, diuretics, mannitol, inotropic agents)
Determination of the cause of the transfusion reaction
Management of infectious complications of blood transfusions
Submission of report of transfusion reactions in accordance with the hospital protocol
Major Outcomes Considered
Incidence of transfusion-related adverse events
Severity of transfusion-related adverse events
Timing of transfusion-related adverse events
Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)Hand-searches of Published Literature (Secondary Sources)Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Relevant articles were found by performing systematic search actions in the Cochrane Library, Medline and EMBASE. The languages were limited to Dutch, English, German and French. Manual searches were also performed. The search was performed from 2003 (Medline) and for some questions also in EMBASE or CINAHL up to and including February 2008.
After the literature search, the result was evaluated by the working group members and the articles were evaluated for clinical relevance. If there was a possibility that the initial question could be answered with the article, the article was included in the selection.
Number of Source Documents
Methods Used to Assess the Quality and Strength of the Evidence
Expert ConsensusWeighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Categorisation of Methodological Quality of Individual Studies
Diagnostic Accuracy of Research
Damage or Adverse Effects, Etiology, Prognosis*
Systematic review of at least two studies performed independently of each other at level A2
Randomised, double-blind, comparative clinical study of good quality and sufficient size
Research with respect to a reference test (a 'golden standard'), with previously defined limits and independent evaluation of the results of test and gold standard, concerning a sufficiently large series of consecutive patients who have only had the index test and reference test
Prospective cohort study of sufficient size and follow-up, with adequate checks for 'confounding' and sufficient exclusion of selective follow-up.
Comparative study, but not with all the characteristics as mentioned under A2 (these also include patient-control study, cohort study)
Study compared to a reference test, but not including all the characteristics mentioned under A2
Prospective cohort study, but not including all characteristics as mentioned under A2 or a retrospective cohort study or patient-control study
*This classification only applies in situations where controlled trials are not possible due to ethical or other reasons. If these are possible, then the classification for interventions applies.
Methods Used to Analyze the Evidence
Review of Published Meta-AnalysesSystematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence
The guidelines and reviews that were found were evaluated for quality by the chairmen with the aid of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.
Methods Used to Formulate the Recommendations
Description of Methods Used to Formulate the Recommendations
Composition of the Core Group and Working Group
The blood transfusion policy guideline working group had a multi-disciplinary composition: as many professionals as possible from various disciplines – involved in blood transfusion – were asked to participate. In composing the working group, a balanced representation was sought of the various disciplines involved, the geographical distribution of the members and the proportion of academic to non-academic institutions. Members of the working group were invited to take part in the working group via the relevant (scientific) associations based on their personal expertise and/or affinity with the subject. They did not receive any payment and/or reimbursement of travel costs for their presence at working group meetings. A small core group was formed from the members of the working group. The working group was chaired by two chairmen, who also acted as chairmen for the core group. The working group members and core group members acted independently and were mandated by their association for participation in the working group.
Working Method for Guideline Development
The revision started with an inventory of the bottlenecks observed in practice with the Blood Transfusion guideline from 2004, which served as a starting point for the revision. The working group members were asked to consult their association members to name and create an inventory of these bottlenecks. The relevant patient groups (see also under 'Patient perspective' in the original guideline document) were also asked to name and create an inventory of the bottlenecks that they experience in the practical situation. Once the bottlenecks had been collected, they were categorised in the relevant chapter. Seven initial questions were distilled from the prioritised bottlenecks for elaboration by a Centraal BegeleidingsOrgaan (CBO) advisor.
Core Group Working Method
The primary task of the core group was to monitor the progress of the entire process, including the results of the working group. The core group members were each responsible for the end result of one or more chapters. The core group also collaborated with the CBO in the final editing of the guideline.
Working Group Working Method
The working group worked on the creation of a draft guideline over a period of two and a half years. The entire working group met on several occasions for plenary discussion, development and approval of the draft texts. The working group worked in small sub-groups outside the plenary meetings on the revision of chapters for the guideline. Some working group members were involved in the revision of several chapters. For each chapter, one working group member was responsible for the revision of the chapter, supported by the core group member(s) with ultimate responsibility.
The CBO information specialist wrote the draft evidence text. These draft evidence texts were then evaluated by the relevant sub-working groups and supplemented with other considerations from the practical setting and recommendations based on the conclusions from the scientific literature and these other considerations.
All draft texts were discussed several times in the plenary working group, commented on and eventually approved.
Texts developed by the working group were then edited by the core group and the CBO to form the draft guideline. Prof. W.G. van Aken, internist n.p., read the draft texts in the final phase critically and made suggestions for improvement.
Where there continued to be a lack of evidence based knowledge on certain subjects despite new literature, the working group – based on discussion and consensus – formulated suggestions and recommendations.
In order to make a recommendation, in addition to scientific proof, there were also other important aspects such as patient perspective, organisational aspects and costs.
Rating Scheme for the Strength of the Recommendations
Level of Conclusions
Research of level A1 or at least 2 studies performed independently at level A2, with consistent results
1 study of level A2 or at least 2 studies performed independently at level B
1 study at level B or C
See the 'Rating Scheme for the Strength of the Evidence' field for definitions of levels A1-C.
Cost-efficacy data are available in the original Dutch language guideline.
Method of Guideline Validation
External Peer ReviewInternal Peer Review
Description of Method of Guideline Validation
The draft guideline, which could be consulted via the Centraal BegeleidingsOrgaan (CBO) website, was submitted to the relevant associations with mandated representatives in the working group for a consultation round (see the original guideline document for mandating organisations). The relevant groups listed under 'Patient perspective' in the original guideline document were also specifically asked to comment on the Blood Transfusion draft guideline. The resulting comments were processed in the definitive draft guideline. Following inclusion of the comments, the draft guideline was submitted to the associations for authorisation and it was approved on 1 August 2011.
Note from the Dutch Institute for Healthcare Improvement Centraal BegeleidingsOrgaan (CBO) (DIHG) and the National Guideline Clearinghouse (NGC): The Blood Transfusion Guideline has been divided into individual summaries covering blood components, laboratory aspects, chronic and acute anemia, platelet and plasma transfusions, side effects, and techniques to save blood. In addition to the current summary, the following are available:
Differential Diagnosis for (Suspected) Acute Transfusion Reactions
A nurse must observe the patient for 5 to 10 minutes after starting the transfusion of each new unit. The vital functions should be recorded at the end of this period. Clearly define which parameters should be monitored (heart rate, temperature, blood pressure, etc.) during transfusion and at what frequency.
In the case of a (suspected) transfusion reaction other than itching or urticaria, the transfusion should be stopped and the unit disconnected if necessary, in consultation with the treating physician. The infusion system should be left in place. Rapid and targeted examination by the blood transfusion laboratory is also required.
The treating physician should be contacted for the differential diagnosis and treatment of acute transfusion reactions. It is recommended that the treating physician follows the algorithm (Figure 7.1 in the original guideline document) 'Suspected Acute Transfusion Reaction' (including explanation) or the hospital's own schedule that has been adapted to the local situation. For more detailed recommendations for (suspected) specific reactions, see 'Non-infectious Complications of Transfusions' below.
If anaphylactic symptoms (such as glottis oedema, hypotension, shock) are present: disconnect the unit immediately, connect a neutral infusion solution (e.g., 0.9% saline [NaCl]) and treat as an anaphylactic reaction: anti-histamines, corticosteroids and adrenalin, if necessary. Consult the transfusion specialist about diagnosis of immunoglobulin A (IgA) deficiency. See also 'Anaphylactic Transfusion Reaction' below.
Before disconnecting the unit, it should first be sealed ('clamped'), in order to prevent the reflux of blood from the patient to the donor unit.
If the blood component is disconnected, it should be returned to the blood transfusion laboratory as soon as possible for further examination. The hospital must provide instructions for disconnection, transport & storage conditions, and the method of sampling and these instructions must be followed.
Reporting: Transfusion reactions must first be reported to the treating doctor and the blood transfusion laboratory. Sanquin Blood Supply should be contacted as soon as possible with each suspected transfusion reaction or incident that may have consequences for other components from this donor (these donors) (for example, suspected bacterial or viral contamination of a unit, suspected transfusion related acute lung injury [TRALI]) The haemovigilance official of the hospital reports all reactions and incidents to the TRIP (Transfusion Reactions in Patients) National Haemovigilance Office. Severe reactions or calamities must also be reported to the Health Care Inspectorate (IGZ). See www.tripnet.nl for reporting and definitions of severity.
The blood sample for compatibility testing (also called cross-match blood) must be stored for seven days at a maximum of 4°C to 8°C for testing of possible transfusion reactions.
Systematic training of nurses in the field of prevention, recognition and treatment of transfusion reactions is indicated.
In addition to a haemovigilance official, each hospital should also have a haemovigilance nurse/employee. An important task of the haemovigilance nurse/employee is the training of all people involved in the prescription and administration of blood components.
The working group is of the opinion that haemovigilance should encompass both transfusions of (short shelf-life) blood components and blood-saving techniques.
Non-infectious Complications of Transfusions
Acute Haemolytic Transfusion Reaction
In the case of a (suspected) acute haemolytic transfusion reaction, the transfusion should be stopped immediately and the unit must be disconnected, blood must be collected for serological testing, haemoglobin (Hb) and haemolysis parameters must be tested and treatment (see recommendation 2) must be started.
The treatment of an acute haemolytic transfusion reaction begins with measures that maintain diuresis:
NaCl 0.9% infusion
Administer diuretics (furosemide), consider mannitol.
In the case of shock, consider using inotropic agents.
The further treatment is symptomatic, with special attention paid to possible disseminated intravascular coagulation (DIC).
There is no role for the administration of corticosteroids.
The remainder of the relevant blood component should be returned to the blood transfusion laboratory immediately in order to determine the cause of the transfusion reaction.
Administrative and laboratory examination into the cause of the transfusion reaction should be performed/requested as soon as possible.
If it is suspected that the supplied blood component was labelled incorrectly, Sanquin Blood Supply should be contacted urgently.
Depending on the nature of the transfusion reaction, a report will be submitted to TRIP/Sanquin Blood Supply/the Health Care Inspectorate in accordance with the relevant hospital protocol.
Data concerning the presence of erythrocyte antibodies should be included in the patient's transfusion history.
The patient's antibody history and TRIX (the TRIX database for irregular red cell antibodies) should be consulted with each request for a cellular blood component (see 'Antibody Identification Study' in the NGC summary of the DIHG guideline Laboratory aspects.
Irregular erythrocyte antibodies should be registered in TRIX.
If clinically relevant antibodies are detected after a recent transfusion, it is recommended to check the patient and/or the laboratory history for the occurrence of any delayed haemolytic transfusion reaction.
Anaphylactic Transfusion Reaction
In the case of a (suspected) anaphylactic reaction, the transfusion should be stopped immediately (see Figure 7.1 in the original guideline document) and treatment must be started. Deficiency of IgA and presence of anti-IgA and anti-IgA sub class antibodies should be considered.
A five times washed erythrocyte concentrate – from which plasma proteins have been virtually completely removed (see 'Erythrocytes' in the NGC summary of the DIHG guideline Blood components: characteristics, indications, logistics and administration) – should only be used for subsequent transfusions in the case of a proven anaphylactic reaction due to antibodies against IgA or a demonstrated IgA deficiency (<0.05 mg/dL [=0.5 mg/L]).
In the case of proven anaphylactic reactions due to antibodies against IgA or demonstrated IgA deficiency (<0.05 mg/dL [=0.5 mg/L]), one should consider using IgA deficient donors for platelet transfusion and transfusion of fresh frozen plasma (see 'Indication for Washed Cellular Components and IgA Deficient Plasma' in the NGC summary of the DIHG guideline Blood components: characteristics, indications, logistics and administration).
It is recommended to administer an anti-histamine in the case of a mild and non-anaphylactic allergic transfusion reaction; usually the transfusion can proceed with caution.
After one (or more) mild and non-anaphylactic allergic transfusion reaction(s), an anti-histamine can be administered as pre-medication for future transfusions.
For patients with mild and non-anaphylactic allergic transfusion reactions, the blood components for administration do not need to undergo any extra processing steps, such as washing.
(Febrile) Non-haemolytic Transfusion Reaction ([F]NHTR) and Mild NHTR
The diagnosis of NHTR is a diagnosis based on exclusion.
An NHTR is never life-threatening, but transfusion reactions that are life-threatening – such as acute haemolysis transfusion reaction (AHTR), bacterial contamination and TRALI – must be ruled out before the diagnosis of NHTR may be made.
When evaluating the cause of an increase in temperature during blood transfusion, the patient's entire clinical condition should be analysed, and a temperature curve should be constructed.
Anti-pyretic medication (paracetamol, non-steroidal anti-inflammatory drugs [NSAIDs]) can be administered to combat the symptoms of an NHTR.
The transfusion can be resumed once an AHTR, bacterial contamination and TRALI have been ruled out.
Transfusion Related Acute Lung Injury
A chest X-ray should be made for every suspected case of TRALI.
(Possible) TRALI is a clinical diagnosis.
Other causes of dyspnoea or hypoxia (transfusion-related or not) – particularly volume overload – should be ruled out before making the diagnosis TRALI.
TRALI must be reported both to TRIP and to Sanquin Blood Supply.
For each transfusion reaction that meets the definition of TRALI, the donor(s) and the patient (in the case of administration of a leukocyte-containing blood component) must be examined for antibodies against human leukocyte antigen (HLA) and/or granulocytes. Sanquin Blood Supply will coordinate this testing.
If dyspnoea, orthopnoea, cyanosis, tachycardia >100 bpm, ankle oedema or elevated central venous pressure occurs during or within six hours after transfusion, one should always consider TACO (also called volume overload) next to TRALI or anaphylactic reaction.
One should consider taking a chest X-ray for each suspected case of TACO (also called volume overload). In the case of TACO, the chest X-ray will give an image consistent with cardiac decompensation.
If TACO (also called volume overload) is diagnosed, treatment should start as early as possible. The transfusion should be stopped immediately and the treatment can consist of the administration of oxygen and diuretics. Bloodletting may also be considered.
In patients who are susceptible to TACO (also called volume overload), it is recommended to transfuse slowly in the future, e.g., 1 mL/kg/hour and/or administer diuretics before and/or during the transfusion.
Post-transfusion Purpura (PTP)
The diagnosis of PTP must be considered in every patient who develops severe thrombocytopaenia within three weeks after a blood transfusion.
In the case of suspected PTP, human platelet antigen (HPA) typing should be performed on the patient in addition to the determination of HPA antibodies.
Intravenous immunoglobulin (IVIG) is the treatment of choice for patients with PTP.
Prophylactic treatment with platelet transfusions is not indicated for PTP. Transfusion with HPA-1a negative platelet concentrates should only be considered in the case of severe bleeding.
Once a patient has experienced PTP, it is recommended for future platelet transfusions to administer platelets obtained from donors who are negative for the antigen against which the antibody is targeted.
Due to iron accumulation caused by secondary haemochromatosis (haemosiderosis), every patient who has received more than 20 erythrocyte units, remains transfusion-dependent and has a life expectancy of more than one year must be started on iron chelation and the ferritin level in the blood must be monitored.
Iron chelation must be started in transfusion-dependent patients with a ferritin level >1000 µg/L and a life expectancy of more than one year.
The aim of iron chelation is to achieve a ferritin level <1000 µg/L and to normalise the magnetic resonance imaging (MRI) pattern of the liver.
Deferoxamine is recommended as the component of choice. Deferiprone is recommended in the case of cardiac iron accumulation, possibly in combination with deferoxamine. Deferasirox is recommended if the patient does not tolerate either of these iron chelators, or in the case of poor therapy compliance resulting in insufficient iron chelation.
Data concerning the presence of HLA and/or HPA antibodies should be included in the patient's transfusion history.
Immunological Effects of Blood Transfusion
Research on the mechanisms and causal factors of immune suppression by blood components is recommended.
Immune-modulating pre-transplantation blood transfusions should only take place as part of a clinical protocol. This research should be set up to achieve informative end points.
Infectious Complications of Blood Transfusions
Infection Due to Bacterial Contamination of Blood Components
One bacterial culture from the component and two blood cultures from the patient must be performed in case of a febrile reaction ≥2°C and/or cold shivers. For a febrile reaction <2°C, blood cultures should be taken depending on the doctor's 'clinical judgement'.
The hospital must provide instructions for disconnection, transport & storage conditions and the method of sampling, and these instructions must be followed.
Infected blood components should be traced by means of a good haemovigilance system. (Suspected) cases of bacterial contamination of blood components should be reported to Sanquin Blood Supply as soon as possible.
If a report of bacterial contamination of a blood component is sent to Sanquin Blood Supply (or another manufacturer) and the blood component has already been administered or is being administered at the time, it is essential to monitor the patient for symptoms of bacteraemia/sepsis.
Post-transfusion Viral Infection
A realistic suspicion of a post-transfusion viral infection should be reported to Sanquin Blood Supply immediately.
In the case of viral hepatitis, the (small) possibility of transmission by a blood transfusion should also be considered.
Each case of PTH – for example by hepatitis B virus (HBV) or hepatitis C virus (HCV) – with a positive blood transfusion history should also be reported to Sanquin Blood Supply.
Post-transfusion Human Immunodeficiency Virus (HIV) Infection/Acquired Immunodeficiency Syndrome (AIDS)
In the case of an HIV infection, the recipient's transfusion history over the past 10 years should be checked.
Each case of HIV infection with a positive blood transfusion history should also be reported to Sanquin Blood Supply.
Post-transfusion Malaria Infection
In the case of malaria in a recipient of erythrocyte transfusions, the (extremely small) possibility of post-transfusion malaria must be considered if other causes have been ruled out.
Post-transfusion Variant Creutzfeldt Jakob Disease (vCJD) Infection
If the diagnosis of CJD or vCJD is made, one should verify whether the patient ever received a transfusion of blood components and whether he/she ever donated blood. If yes, this should be reported to the Health Care Inspectorate and in the case of blood donation also to Sanquin Blood Supply.
A clinical algorithm for the differential diagnosis of acute transfusion reaction (an example of an existing protocol) is provided in the original guideline document.
Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of evidence supporting the recommendations is not specifically stated.
The recommendations for management of non-infectious transfusion reactions/complications are based on the opinions of experts, international guidelines and manuals.
Benefits/Harms of Implementing the Guideline Recommendations
Appropriate and safe management of patients who experience a transfusion reaction after receiving blood components for transfusion
Unfortunately, there are no pathognomonic symptoms in transfusion-associated graft-versus-host disease (TA-GVHD) and the diagnosis will often be missed as a result of the extensive differential diagnosis (including reaction to medication, viral and bacterial infection).
Acute haemolytic transfusion reaction is rare, but the true incidence is hard to determine due to under-reporting and the diagnosis can also be missed because the clinical symptoms are not specific.
Guidelines are not legal instructions, but rather scientifically substantiated and/or broadly accepted insights and recommendations that care providers should follow in order to offer good quality care. As guidelines are based on 'the average patient', care providers can, if necessary, deviate from the recommendations in the guideline in individual cases. Sometimes it may even be essential to deviate from guidelines if the patient's situation demands this. However, if a conscious decision is made to deviate from the guideline, a case must be made for this and it must be documented. One should also consider whether this should be discussed with the patient, or whether the patient should be informed.
Implementation of the Guideline
Description of Implementation Strategy
The guideline was initially disseminated through the websites of scientific and professional associations that were involved and made available through the website of the Centraal BegeleidingsOrgaan (CBO; www.cbo.nl ).
The definitive guideline will be disseminated amongst the associations and will be available in digital format. The recommendations of the guideline will be presented at scientific meetings of the relevant scientific associations. An announcement of this guideline will be submitted for publication to the Netherlands Journal of Medicine, the Journal for Blood Transfusion and the Netherlands Journal of Clinical Chemistry and Laboratory Medicine.
In order to stimulate the implementation and evaluation of this guideline, internal indicators have been developed, which allow for the implementation to be measured by random sampling. In general, indicators give the care providers the opportunity to evaluate whether they are providing the desired care. This enables them also to identify subjects for improvement of the care provision. The internal indicators that were developed for this guideline are discussed in Chapter 9 of the original guideline document.
Audit Criteria/IndicatorsClinical AlgorithmForeign Language TranslationsPocket Guide/Reference Cards
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.
Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Getting BetterLiving with IllnessStaying Healthy
Identifying Information and Availability
Transfusion reactions and related conditions. In: Blood transfusion guideline. Utrecht (The Netherlands): Dutch Institute for Healthcare Improvement CBO; 2011. p. 278-320. [156 references]
Not applicable: The guideline was not adapted from another source.
Dutch Institute for Healthcare Improvement CBO - Professional Association
Source(s) of Funding
The Blood Transfusion Policy guideline project was financed by The Netherlands Organisation for Health Research and Development (ZonMw) within the programme Knowledge Policy Quality of Curative Care.
The Dutch Institute for Healthcare Improvement Centraal BegeleidingsOrgaan (CBO) (DIHG) is extremely grateful to the Sanquin Blood Supply Foundation for financing this translation.
Dutch Institute for Healthcare Improvement Centraal BegeleidingsOrgaan (CBO) (DIHG) Working Group
Composition of Group That Authored the Guideline
Core Group Members: F.J.L.M. Haas (Chairman), Prof. D.J. van Rhenen, Prof. R.R.P. de Vries (Chairman), Mrs M.A.M. Overbeeke, Dr V.M.J. Novotny, Dr Ch.P. Henny
Working Group Members: Prof. A. Brand, internist-haematologist, manager of research & education, Sanquin Blood Supply Region SW, Department of Research & Education, Leiden; Ms H. de Bruijn-van Beek, general secretary board, Sanquin Blood Supply, Amsterdam; Dr C.L. van der Poel, transfusion doctor-epidemiologist, Secretary for medical affairs, Sanquin Blood Supply, Group personnel, Amsterdam; Dr E.A.M. Beckers, transfusion specialist, University Medical Centre, Haematology Department, Maastricht; T. Reker, transplant coordinator, University Medical Centre, Groningen [until 01-05-2009]; Ms N.W.M. Gerrits, senior nurse haematology/oncology, Onze Lieve Vrouwe Gasthuis, ward C6, Amsterdam; Dr Ch.P. Henny, anaesthesiologist, Academic Medical Centre, Anaesthesiology department, Amsterdam; Dr A.W.M.M. Koopman-van Gemert, anaesthesiologist-intensivist, Albert Schweitzer Hospital, location Dordtwijk, Anaesthesiology department, Dordrecht; Dr A.W.M.M. Koopman-van Gemert, anaesthesiologist-intensivist, Albert Schweitzer Hospital, location Dordtwijk, Anaesthesiology department, Dordrecht; Dr V.M.J. Novotny, internist-haematologist/blood transfusion specialist, St. Radboud University Medical Centre, Haematology department, Nijmegen; Mrs M.A.M. Overbeeke, biologist, head of Immunohaematology department, Sanquin Blood Supply, Diagnostics Division, Amsterdam; Mrs M. Smelt, haemovigilance employee, St. Antonius Hospital, Clinical Chemistry Laboratory, Nieuwegein; Dr M.R. Schipperus, internist-haematologist, Haga Hospital, Haematology department, The Hague; Dr J. Schönberger, cardiothoracic surgeon, Catharina Hospital, Department of Cardiothoracic Surgery, Eindhoven; Dr R.Y.J. Tamminga, paediatrician, oncologist-haematologist, University Medical Centre, Beatrix Children's Clinic, Groningen; Dr C.H. van Ommen, paediatrician-haematologist, Academic Medical Centre, department of Paediatric Haematology, Amsterdam; Dr. E. Lopriore, paediatrician-neonatologist, Leiden University Medical Centre, department of neonatology, Leiden; Dr R.C.R.M. Vossen, clinical chemist, Orbis Medical Centre, clinical chemistry & haematology laboratory, Sittard; Dr J. Slomp, clinical chemist, Medical Spectrum Twente, Laboratory, Enschede; Prof. D.J. van Rhenen, internist-haematologist, division director Sanquin Blood Supply, SW Region, Rotterdam; Dr J.J. Zwaginga, staff member blood transfusion service, head of stem cell therapy centre, Leiden University Medical Centre, department of Immunohaematology, Leiden; Dr B.J. Biemond, internist-haematologist, Academic Medical Centre/University of Amsterdam, department of Internal Medicine, Amsterdam; Dr J.Th.M. de Wolf, internist-haematologist, University Medical Centre, Groningen (until 01-04-2009); Dr R.E.G. Schutgens, internist-haematologist, University Medical Centre, Utrecht (as of 15-04-2009); Dr P.J. Kabel, physician-microbiologist, Regional Laboratory for Public Health, LMMI department, Tilburg; Dr G.C.M.L. Page-Christiaens, perinatologist, University Medical Centre, Obstetric department, Utrecht; Dr J.G. Loeber, clinical chemist, head of laboratory, RIVM, LIS department, Bilthoven (Chapter 9: Indicators); Dr A. Castel (up to and including February 2009); Dr Y.B. de Rijke, (as of March 2009), clinical chemist, Erasmus Medical Centre, department of Clinical Chemistry, Rotterdam; H.E. Polak, anaesthesiology nurse, Via Sana Clinic, Mill; Prof. R.J. Porte, University Medical Centre, department of Surgery, Groningen; W.G. Horstmann (up to and including March 2009)]; D.B. van der Schaaf, orthopaedic surgeon, Sint Maartens Clinic, Orthopaedics department, Nijmegen (as of April 2009)
Financial Disclosures/Conflicts of Interest
No relationships relevant to this guideline of working group members with the pharmaceutical industry were reported.
This NGC summary was completed by ECRI Institute on October 9, 2012. The information was verified by the guideline developer on November 14, 2012. This summary was updated by ECRI Institute on October 28, 2013 following the U.S. Food and Drug Administration advisory on Acetaminophen.
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